Acute gastrointestinal injury in critically ill patients with coronavirus disease 2019 in Wuhan, China

Jia-Kui Sun

That's why the COVID-19 patients were susceptible to ARDS and even MODS. Our findings also showed that ARDS incidence was very high (92.8%), and AGI grades were significantly positive correlated with MV days. Liang et al. reported that ACE2 was highly expressed in small intestine, especially in proximal and distal enterocytes (19) . ACE2 expression in the epithelial cells was required for maintaining antimicrobial peptide expression, amino acid homeostasis, and the ecology of gut microbiome in intestine (20) . Therefore, gastrointestinal symptoms were also reported in previous studies on COVID-19 (7, 8) . We believed that these gastrointestinal All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Yang et al. (9) reported that ARDS developed in 67%, AKI in 29%, cardiac injury in 23%, and liver dysfunction in 29% of critically ill patients with SARS-CoV-2 pneumonia. Zhou's study (21) presented that septic shock developed in 20%, ARDS in 31%, AKI in 15%, and cardiac injury in 17% of total patients with COVID-19. Our results showed that ARDS developed in 92.8%, AKI in 36.1%, cardiac injury in 44.6%, and liver injury in 18.1% of the critically ill patients with COVID-19. The incidences of organ injury in this study were higher than those of previous studies, which may suggest that patients with AGI had worse clinical outcomes. The high MODS incidence (69.9%) and hospital mortality (48.2%) of critically ill patients in this study also confirmed this conclusion. Moreover, we found that the hospital days of patients without AGI were significantly longer than that of patients with AGI. It could be explained by the high 28-d mortality in patients with AGI, because the median hospital stay of non-survivors was only 12.0 (IQR, 8.0-17.8) days, ranging from 3 days to 27 days.